Point of care testing: Transcutaneous bilirubinometry in neonates

Physicians taking care of infants in the first days of life are often faced with neonatal jaundice, especially in ail era where post-partum discharge occurs earlier and assessment of newborn bilirubinemia status is required prior to discharge. The Canadian Pediatric Society and the American Academy of Pediatrics have developed and published guidelines for the diagnosis and management of hyperbilirubinemia in newborns. Point of care testing refers to any test performed outside of laboratory by clinical personnel and close to the site of patient care. Based on a summary of multiple reports during the last twenty years, we realize that devices which provide a non-invasive transcutaneous bilirubin (TcB) measurement have proven to be very useful as screening tools and provide a valid estimate of the total scrum bilirubin level (TSB). Published data suggest that these devices provide measurements within 30 50 mu mol/L of the TSB levels and can replace laboratory measurement particularly when TSB levels are less than 260 mu mol/L. At the present time, in the literature, evidence is insufficient to abandon neonatal serum bilirubin testing and replace it with TcB. Any measurement, TSB or TcB, has potential for error. However, we have evidence that TcB, can help avoiding potential errors associated with even visual assessment of jaundice and may be useful as screening device to detect significant jaundice and decrease a large number of unnecessary skin punctures. The current manuscript is based on a careful comprehensive literature review concerning neonatal hyperbilirubinemia. We consider that this manuscript will help clinicians and laboratory professionals m the management of neonatal jaundice. (C) 2008 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.